Adversaries becoming friends – payers and big pharma are pooling capabilities to tackle healthcare inefficiencies

by Torsten Bernewitz

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The relationships between pharmaceutical companies and health plans are usually not easy. They are parties sitting on opposite sides of the negotiating table, and frequently regard each other with suspicion.

But some change may be coming our way. If we want to stem the tide of ever rising healthcare costs, we need to get better at leveraging clinical evidence and comparative effectiveness data to steer the appropriate care, medications and services to the right patients, at the right time.

The different stakeholders in healthcare each hold different pieces of this puzzle. Payers have extensive data about healthcare utilization, outcomes and costs. Providers have the expertise in diagnosis and treatment protocols that determine the patient’s journey and experience along the way. Medical manufacturers have strong market research capabilities to understand provider and patient needs, attitudes and behaviors, the marketing skills to influence change, and the research and development capabilities to create new pharmaceuticals and devices to provide new solutions. Bringing all of this to the same table can be a win-win for everyone involved, including the patient.

This year we have already seen two prominent examples of different stakeholders working together in new ways.

Yesterday, Humana and Pfizer announced that they join forces in a five-year research partnership. The goal is to explore new ideas and ways to improve the quality, outcomes and costs of the healthcare delivery system, in particular for senior citizens.

Both organizations will bring together researchers and healthcare experts to study key issues and deliver interventions to reduce inefficiencies in the management of chronic conditions such as pain, cardiovascular disease and Alzheimer’s.

Humana expects to get from this collaboration a deeper understanding of their members’ needs, their behaviors, and the underlying drivers for health and well-being. The results could shape how Humana designs benefit and coverage plans, and what programs will be developed to influence how patients take their medications.

For Pfizer, the research will provide important pointers to influence pipeline strategy decisions. And of course they will get a better appreciation of how payers think and make decisions.

Earlier this year, AstraZeneca and WellPoint entered into as similar partnership to determine the most effective and economical treatments for chronic illnesses and other diseases.

In this collaboration, which is expected to run over the next four years, WellPoint and AstraZeneca will share and analyze electronic medical records, claims information and patient surveys from people insured by WellPoint and several regional Blue Cross Blue Shield plans.

The research will include prospective and retrospective observational studies on disease states as well as comparative effectiveness research of multiple treatment options. It will also highlight new therapies most needed for treating and preventing disease.

The companies plan to make their findings publicly available and to expand their partnership to include hospitals and other organizations.

These partnerships bear all the hallmarks of value-based relationships. They are significantly different from the key account management (KAM) and contracting strategies that usually characterize the approach of pharma companies when they interact with payer organizations.

This is not about selling products and/or services. It is not about pricing and rebating for access. Instead, it means bringing capabilities from both partners to the table to solve a problem or develop solutions together.

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Torsten Bernewitz is a healthcare industry analyst and management consultant.
He is Managing Principal, Healthcare Insurers and Payers at ZS Associates.

This post is the author’s own and does not necessarily represent ZS Associates’ positions, strategies or opinions.

Contact: torsten.bernewitz@zsassociates.com